title: Effectiveness of knowledge translation interventions to improve cancer pain management.
abstract: BACKGROUND
  Cancer pain is prevalent, yet patients do not receive best care despite widely available evidence. Although national cancer control policies call for education, effectiveness of such programs is unclear and best practices are not well defined.
  
  
  OBJECTIVE
  To examine existing evidence on whether knowledge translation (KT) interventions targeting health care providers, patients, and caregivers improve cancer pain outcomes.
  
  
  METHODS
  A systematic review and meta-analysis were undertaken to evaluate primary studies that examined effects of KT interventions on providers and patients.
  
  
  RESULTS
  Twenty-six studies met the inclusion criteria. Five studies reported interventions targeting health care providers, four focused on patients or their families, one study examined patients and their significant others, and 16 studies examined patients only. Seven quantitative comparisons measured the statistical effects of interventions. A significant difference favoring the treatment group in least pain intensity (95% confidence interval [CI]: 0.44, 1.42) and in usual pain/average pain (95% CI: 0.13, 0.74) was observed. No other statistical differences were observed. However, most studies were assessed as having high risk of bias and failed to report sufficient information about the intervention dose, quality of educational material, fidelity, and other key factors required to evaluate effectiveness of intervention design.
  
  
  CONCLUSIONS
  Trials that used a higher dose of KT intervention (characterized by extensive follow-up, comprehensive educational program, and higher resource allocation) were significantly more likely to have positive results than trials that did not use this approach. Further attention to methodological issues to improve educational interventions and research to clarify factors that lead to better pain control are urgently needed.
authors.affiliation: CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Alberta, Canada. gretac@ualberta.ca
authors.forename: Greta G
authors.initials: GG
authors.lastname: Cummings
authors.forename: Susan Armijo
authors.initials: SA
authors.lastname: Olivo
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Biondo
authors.forename: Carla R
authors.initials: CR
authors.lastname: Stiles
authors.forename: Ozden
authors.initials: O
authors.lastname: Yurtseven
authors.forename: Robin L
authors.initials: RL
authors.lastname: Fainsinger
authors.forename: Neil A
authors.initials: NA
authors.lastname: Hagen
mesh_terms: D005260:Female; D006801:Humans; D051188:Knowledge Bases; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D010146:Pain / Q000453:epidemiology*; D059408:Pain Management; D010166:Palliative Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D015995:Prevalence; D016896:Treatment Outcome